Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016

Abstract

Importance: Suicide is a leading cause of death among youth aged 10 to 19 years in the United States, with rates traditionally higher in male than in female youth. Recent national mortality data suggest this gap may be narrowing, which warrants investigation.

Objective: To investigate trends in suicide rates among US youth aged 10 to 19 years by age group, sex, race/ethnicity, and method of suicide.

Design, setting, and participants: Cross-sectional study using period trend analysis of US suicide decedents aged 10 to 19 years from January 1, 1975, to December 31, 2016. Data were analyzed for periods defined by statistically significant changes in suicide rate trends. Suicide rates were calculated using population estimates.

Main outcomes and measures: Period trends in suicide rates by sex and age group were assessed using joinpoint regression. Incidence rate ratios (IRRs) were estimated using negative binomial regression comparing male and female suicide rates within periods.

Results: From 1975 to 2016, we identified 85 051 youth suicide deaths in the United States (68 085 male [80.1%] and 16 966 female [19.9%]) with a male to female IRR of 3.82 (95% CI, 3.35-4.35). Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years; 7.9% vs 3.5% for individuals aged 15-19 years). The male to female IRR decreased significantly across the study period for youth aged 10 to 14 years (3.14 [95% CI, 2.74-3.61] to 1.80 [95% CI, 1.53-2.12]) and 15 to 19 years (4.15 [95% CI, 3.79-4.54] to 3.31 [95% CI, 2.96-3.69]). Significant declining trends in the male to female IRR were found in non-Hispanic white youth aged 10 to 14 years (3.27 [95% CI, 2.68-4.00] to 2.04 [95% CI, 1.45-2.89]) and non-Hispanic youth of other races aged 15 to 19 years (4.02 [95% CI, 3.29-4.92] to 2.35 [95% CI, 2.00-2.76]). The male to female IRR for firearms increased significantly for youth aged 15 to 19 years (χ2 = 7.74; P = .02 for sex × period interaction). The male to female IRR of suicide by hanging or suffocation decreased significantly for both age groups (10-14 years: χ2 = 88.83; P < .001 for sex × period interaction and 15-19 years: χ2 = 82.15; P < .001 for sex × period interaction). No significant change was found in the male to female IRR of suicide by poisoning across the study period.

Conclusions and relevance: A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted.

Figure 1.. Suicide Trends Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016

Suicide rate trends are displayed as linear segments connected at the joinpoint or year when the slope of each trend changes significantly. Data markers indicate observed rates and solid colored lines indicate model rates.

Figure 2.. Male to Female Incidence Rate Ratios of Suicide Rates Among Youth Aged 10 to 14 Years in the United States, 1975 to 2016, by Race/Ethnicity

Circles indicate the estimated natural logarithm of the period-specific incidence rate ratio and vertical lines, the 95% confidence intervals. The reference group is female youth. The 95% confidence intervals that do not include 0 are considered statistically significant. Periods reflect significant linear segment trends associated with female youth in joinpoint analyses. Other race includes American Indian or Alaskan Native and Asian or Pacific Islander. Information on Hispanic ethnicity was only available for 1990 onward and excludes data from the following states and years: Alabama, 1990; Oklahoma, 1990-1996; New Hampshire, 1990-1992; and Louisiana, 1990-1991.

Figure 3.. Male to Female Incidence Rate Ratios of Suicide Rates Among Youth Aged 15 to 19 Years in the United States, 1975 to 2016, by Race/Ethnicity

Circles indicate the estimated natural logarithm of the period-specific incidence rate ratio and vertical lines, 95% confidence intervals. The reference group is female youth. The 95% confidence intervals that do not include 0 are considered statistically significant. Periods reflect significant linear segment trends associated with female youth in joinpoint analyses. Other race includes American Indian or Alaskan Native and Asian or Pacific Islander. Information on Hispanic ethnicity was only available for 1990 onward and excludes data from the following states and years: Alabama, 1990; Oklahoma, 1990-1996; New Hampshire, 1990-1992; and Louisiana, 1990-1991.

Figure 4.. Male to Female Incidence Rate Ratios of Suicide Rates Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016, by Method

Circles indicate the estimated natural logarithm of the period-specific incidence rate ratio and vertical lines, 95% confidence intervals. The reference group is female youth. The 95% confidence intervals that do not include 0 are considered statistically significant. Periods reflect significant linear segment trends associated with female youth in joinpoint analyses.